Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 5201004603 | MI |
NPI | 1629457924 |
---|---|
Provider Name | Kristin Laidlaw |
First Address | Grand Rapids, MI 49525-9580 |
Second Address | Grand Rapids, MI 49525-9580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2015 |
Last Update Date | 20/05/2015 |